{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:30:45Z","timestamp":1787009445226,"version":"build-2736575974"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T00:00:00Z","timestamp":1741132800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001125","name":"GAVI","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001125","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100027925","name":"Alliance","doi-asserted-by":"publisher","award":["GAVI-RFP-2019-001"],"award-info":[{"award-number":["GAVI-RFP-2019-001"]}],"id":[{"id":"10.13039\/100027925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Typhoid fever burdens low- and middle-income countries, especially children. Despite being curable, it now resists first-line antibiotics. This study aims to understand antimicrobial resistance patterns associated with multidrug-resistant (MDR) and extensively drug-resistant (XDR) typhoid fever cases in Pakistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective review of blood culture\u2013confirmed typhoid cases from 5 large laboratory networks in Pakistan over a period of 3 years (2017\u20132019). Data were analyzed for 464 956 blood culture specimens, of which Typhi and Paratyphi were isolated in 23 924 (5%) of all blood cultures done.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sindh had the highest proportion of S. Typhi cases (72%) of all positive cases, followed by Punjab with 46.9%. The 5\u201314-years age group had the highest proportion of S. Typhi (MDR: 46.1%; XDR: 44.2%), followed by the 2\u20134-years age group (MDR: 27%; XDR: 26.2%). XDR isolates of S. Typhi were found in 57%. Most S. Typhi isolates were resistant to ampicillin (79.8%), chloramphenicol (80.8%), cefixime (64.6%), ciprofloxacin (66.4%), ceftriaxone (63.3%), and co-trimoxazole (80.2%). Most S. Paratyphi isolates were responsive to antibiotics, ampicillin (97.2%), chloramphenicol (98.6%), cefixime (99.5%), ceftriaxone (99.5%), and co-trimoxazole (98.7%). Resistance to ciprofloxacin was 85.9%. Both S. Typhi and S. Paratyphi were susceptible to azithromycin and imipenem, whereas 99.8% of S. Typhi and 100% of S. Paratyphi were sensitive to meropenem.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Increased prevalence of culture-confirmed XDR S. Typhi cases was observed in 2019 as compared with 2017, presumably due to the outbreak of XDR in Sindh.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf106","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T07:37:55Z","timestamp":1740123475000},"source":"Crossref","is-referenced-by-count":5,"title":["Trends of Enteric Fever and Emergence of Extensively Drug-Resistant Typhoid in Pakistan: Population-Based Laboratory Data From 2017\u20132019"],"prefix":"10.1093","volume":"12","author":[{"given":"Farah Naz","family":"Qamar","sequence":"first","affiliation":[{"name":"Department of Paediatrics & Child Health, Aga Khan University , Karachi ,","place":["Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8840-8323","authenticated-orcid":false,"given":"Mohammad Tahir","family":"Yousafzai","sequence":"additional","affiliation":[{"name":"Department of Paediatrics & Child Health, Aga Khan University , Karachi ,","place":["Pakistan"]},{"name":"School of Population Health, UNSW Sydney , Sydney ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibtisam","family":"Qazi","sequence":"additional","affiliation":[{"name":"Department of Paediatrics & Child Health, Aga Khan University , Karachi ,","place":["Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Paediatrics & Child Health, Aga Khan University , Karachi ,","place":["Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0570-4624","authenticated-orcid":false,"given":"Naor","family":"Bar-Zeev","sequence":"additional","affiliation":[{"name":"International Vaccine Access Center, Department of International Health, John Hopkins Bloomberg School of Public Health , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shazia","family":"Sultana","sequence":"additional","affiliation":[{"name":"Department of Paediatrics & Child Health, Aga Khan University , Karachi ,","place":["Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Jawwad","sequence":"additional","affiliation":[{"name":"Department of Paediatrics & Child Health, Aga Khan University , Karachi ,","place":["Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aneeta","family":"Hotwani","sequence":"additional","affiliation":[{"name":"Department of Paediatrics & Child Health, Aga Khan University , Karachi ,","place":["Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema","family":"Irfan","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, The Aga Khan University , Karachi ,","place":["Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Ashraf","family":"Memon","sequence":"additional","affiliation":[{"name":"Kharadar General Hospital, Karachi ,","place":["Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irim","family":"Iftikhar","sequence":"additional","affiliation":[{"name":"Chughtai Laboratory , Lahore ,","place":["Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9725-3685","authenticated-orcid":false,"given":"Summiya","family":"Nizamuddin","sequence":"additional","affiliation":[{"name":"Section of Microbiology, Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre , Lahore ,","place":["Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ikram","family":"Ujjan","sequence":"additional","affiliation":[{"name":"LUHMS Laboratory , Hyderabad ,","place":["Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ejaz Ahmed","family":"Khan","sequence":"additional","affiliation":[{"name":"Shifa International Hospital, Shifa Tameer-e-Millat University , Islamabad ,","place":["Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohsina Noor","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"National Institute of Child Health , Karachi ,","place":["Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,3,5]]},"reference":[{"key":"2025052712084019300_ofaf106-B1","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/S1473-3099(18)30685-6","article-title":"The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017","volume":"19","author":"GBD 2017 Typhoid and Paratyphoid Collaborators","year":"2019","journal-title":"Lancet Infect Dis"},{"key":"2025052712084019300_ofaf106-B2","doi-asserted-by":"crossref","first-page":"e978","DOI":"10.1016\/S2214-109X(22)00119-X","article-title":"Incidence of typhoid and paratyphoid fever in Bangladesh, Nepal, and Pakistan: results of the Surveillance for Enteric Fever in Asia Project","volume":"10","author":"Garrett","year":"2022","journal-title":"Lancet Glob Health"},{"key":"2025052712084019300_ofaf106-B3","doi-asserted-by":"crossref","first-page":"S276","DOI":"10.1093\/cid\/ciaa1323","article-title":"Antimicrobial resistance in typhoidal Salmonella: surveillance for Enteric Fever in Asia Project, 2016\u20132019","volume":"71","author":"Qamar","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2025052712084019300_ofaf106-B4","doi-asserted-by":"crossref","first-page":"S214","DOI":"10.1093\/cid\/ciaa1308","article-title":"Burden of culture confirmed enteric fever cases in Karachi, Pakistan: surveillance for Enteric Fever in Asia Project (SEAP), 2016\u20132019","volume":"71","author":"Yousafzai","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2025052712084019300_ofaf106-B5","first-page":"51","article-title":"Extensively drug resistant typhoid fever seen at tertiary care hospital in Lahore","volume":"28","author":"Latif","year":"2019","journal-title":"Infect Dis J Pakistan"},{"key":"2025052712084019300_ofaf106-B6","author":"CLSI"},{"key":"2025052712084019300_ofaf106-B7","doi-asserted-by":"crossref","first-page":"taz095","DOI":"10.1093\/jtm\/taz095","article-title":"Antimicrobial resistance: a global public health emergency further exacerbated by international travel","volume":"27","author":"Holubar","year":"2020","journal-title":"J Travel Med"},{"key":"2025052712084019300_ofaf106-B8","doi-asserted-by":"crossref","first-page":"11","DOI":"10.15585\/mmwr.mm6801a3","article-title":"Emergence of extensively drug-resistant Salmonella Typhi infections among travelers to or from Pakistan\u2014United States, 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Utility of Ty21a vaccine (Vivotif\u00ae)","volume":"58","author":"Amicizia","year":"2017","journal-title":"J Prev Med Hyg"},{"key":"2025052712084019300_ofaf106-B15","doi-asserted-by":"crossref","first-page":"704","DOI":"10.3855\/jidc.1967","article-title":"Epidemiology, clinical presentation, and patterns of drug resistance of Salmonella Typhi in Karachi, Pakistan","volume":"6","author":"Khan","year":"2012","journal-title":"J Infect Dev Ctries"},{"key":"2025052712084019300_ofaf106-B16","first-page":"929","article-title":"Typhoid fever in paediatric patients in Quetta, Balochistan, Pakistan","volume":"29","author":"Naeem Khan","year":"2013","journal-title":"Pak J Med Sci"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofaf106\/62279293\/ofaf106.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/4\/ofaf106\/62279293\/ofaf106.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/4\/ofaf106\/62279293\/ofaf106.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T12:09:21Z","timestamp":1748347761000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofaf106\/8052886"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,5]]},"references-count":16,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,3,27]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofaf106","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,4]]},"published":{"date-parts":[[2025,3,5]]},"article-number":"ofaf106"}}